Читать книгу Emergency Medical Services - Группа авторов - Страница 151

Spontaneous pneumothorax is an uncommon condition that can present with acute respiratory distress. Risk factors for the development of a spontaneous pneumothorax include smoking history, underlying lung disease (e.g., COPD, tumor, infection, or a connective tissue disorder), positive‐pressure ventilation, and being male, with a tall, slender build [70]. A spontaneous pneumothorax is typically caused by rupture of the alveolar air sacs (i.e., subpleural bleb), leading to air accumulation between the parietal and visceral pleura, followed by variable collapse of the lung. Tension pneumothorax is a life‐threatening condition that occurs when the intrathoracic pressure increases due to air trapping from a valve‐like defect in the visceral pleura. This results in hemodynamic compromise from impaired venous return and decreased cardiac output.

Symptoms of spontaneous pneumothorax include dyspnea and pleuritic chest pain. The examination may reveal tachycardia, unilateral decreased breath sounds on the affected side, asymmetrical chest rise, and chest wall crepitus. Patients with a suspected simple pneumothorax should be monitored closely for evidence of tension physiology such as worsening respiratory distress, hypoxia, and hypotension. Jugular venous distension and tracheal deviation are late findings of tension pneumothorax and should not be relied on to confirm this diagnosis. If available, ultrasound can be a valuable tool to assess for a potential pneumothorax, with both high sensitivity and specificity [10, 11]. Imaging will reveal an absence of lung sliding on the affected side. Intubated patients receiving positive‐pressure ventilation are at greater risk for developing a tension pneumothorax and should be monitored closely.

Patients should be treated with supportive care, including oxygen, as indicated. If tension pneumothorax is suspected, immediate chest wall decompression is indicated. This can be achieved through needle or finger thoracostomy, depending on clinician scope of practice and training [71, 72]. (See Chapter 40.)